Weber et al.

Israel Journal of Health Policy Research (2016) 5:61

DOI 10.1186/s13584-016-0122-3

COMMENTARY Open Access

How to improve influenza vaccine

coverage of healthcare personnel
David J. Weber1,2*, Walter Orenstein3 and William A. Rutala1,2

Abstract
Influenza causes substantial morbidity and mortality worldwide each year. Healthcare-associated influenza is a frequent
event. Health care personnel (HCP) may be the source for infecting patients and may propagate nosocomial outbreaks.
All HCP should receive a dose of influenza vaccine each year to protect themselves and others. This commentary will
discuss the study recently published in the IJHPR by Nutman and Yoeli which assessed the beliefs and attitudes of HCP
in an Israel hospital regarding influenza and the influenza vaccine. Unfortunately, as noted by Nutman and Yoeli in this
issue many HCP in Israel choose not to receive influenza immunization and many harbor misconceptions regarding
their risk for influenza as well as the benefits of influenza vaccine. We also discuss proven methods to increase
acceptance by HCP for receiving an annual influenza vaccine.
Keywords: Occupational health, Healthcare personnel, Vaccines, Influenza

Background be recommended in specific countries and for relief

Protecting healthcare personnel (HCP) and patients from
acquiring an infectious disease via person-to-person
spread requires strict adherence to key infection preven-
tion and occupational health recommendations [1]. First,
hand hygiene before and after every patient contact and at
other appropriate times [2]. Second, use of Standard
Precautions by HCP when providing care for all patients
(i.e., use of appropriate personal protective equipment to
prevent contact with infectious body fluids or aerosols)
[3]. Third, rapid evaluation of patients with a known or
suspected communicable disease and institution of appro-
priate isolation precautions (i.e., Contact, Droplet and/or
Airborne) [3]. Finally, immunizations of all HCP to pre-
vent vaccine preventable diseases [1, 4–8]. In developed
countries this would include: mumps-measles-rubella,
varicella, tetanus-diphtheria-acellular pertussis, hepa-
titis B (HCP who have potential exposure to contami-
nated blood or body fluids), Neisseria meningitidis
(microbiologists), and influenza. Additional vaccines
(e.g., polio, hepatitis A, Bacillus Calmette-Guerin) may
* Correspondence: dweber@unch.unc.edu
1
Department of Hospital Epidemiology, University of North Carolina Health
Care, 2163 Bioinformatics, CB #7030, Chapel Hill, NC 27599-7030, USA
2
Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC,
USA
Full list of author information is available at the end of the article
workers [6–8].
Influenza occurs globally with an annual attack rate
estimated at 5% to 10% in adults and 20% to 30% in chil-
dren [9]. Infection may result in hospitalization and
death, especially among high-risk groups (e.g., the very
young, older adults, chronically ill, and/or immunocom-
promised). The World Health Organization (WHO) esti-
mates that these annual epidemics result in 3 to 5
million cases of severe illness, and about 250,000 to
500,000 deaths [9]. It is important to remember several
aspects of influenza epidemiology: influenza is easily
spread from person-to-person; it can affect anybody in
any age group; seasonal influenza is a serious public
health problem that causes severe illness and death in
high risk populations; prior influenza disease does not
assure immunity because the virus frequently mutates
from year-to-year (antigenic drift; although antiviral
drugs are available for treatment, influenza viruses can
develop resistance to drugs; and, influenza vaccination is
the most effective way to prevent influenza [9].
Healthcare-associated influenza is a major worldwide
problem for several reasons [10–12]. First, hospitals
provide care to persons at high-risk for morbidity and
mortality if they acquire influenza including healthcare-
associated infection including neonates, older persons,
those with chronic Illnesses (e.g., diabetes, heart disease,

© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Weber et al. Israel Journal of Health Policy Research (2016) 5:61
asthma, lung disease) and immunocompromised per-
sons. Second, nosocomial outbreaks are frequent and
their control remains challenging. Third, the diagnosis
of influenza is commonly missed because many infected
and infectious persons are asymptomatic or mildly
symptomatic and the clinical signs and symptoms of influ-
enza can be confused with similar illnesses caused by a var-
iety of other pathogens. Further, persons with influenza
may be infectious prior to the onset of symptoms. Fourth,
molecular analyses have revealed transmission between pa-
tients and HCP, and HCP and patients. HCP have served
both as sources of nosocomial outbreaks and propagators
of healthcare-associated outbreaks. Fifth, immunization of
HCP (4 cluster randomized trials and 4 observational stud-
ies) conducted in long-term care or hospital settings has
demonstrated that immunization of HCP demonstrates a
“significant protective association for influenza-like illness
and laboratory-confirmed influenza’ [13].
As noted by the Society for Healthcare Epidemiology
of America (SHEA), influenza vaccination of HCP serves
several purposes: (1) to prevent transmission to patients,
including those with a lower likelihood of vaccination
response themselves; (2) to reduce the risk that the HCP
will become infected with influenza; (3) to create “herd
immunity” that protects both HCP and patients who are
unable to receive vaccine or unlikely to respond with a
sufficient antibody response; (4) to maintain a critical so-
cietal workforce during disease outbreaks; and (5) to set
an example concerning the importance of vaccination
for every person [11].
For the reasons listed above, influenza immunization an-
nually of all HCP is recommended by the World Health
Organization [6], the Centers for Disease Control and Pre-
vention [4, 5, 10], almost all countries in Europe [7, 8],
other countries around the world [8], and many profes-
sional organizations. Further, the Israel Minister of Health
includes coverage rates among its ongoing quality
measures for healthcare organizations, and this may be
helping increase coverage rates. Nevertheless, influenza
immunization of HCP is challenging for two key reasons:
(1) the vaccine efficacy varies year-to-year depending on
how well the strains in the vaccine match with the circulat-
ing strains and (2) the vaccine must be provided each year.
Two key issues regarding achieving high influenza vaccine
coverage of HCP are discussed below. First, what has been
reported in the scientific literature regarding why HCP are
willing or not willing to receive influenza vaccine? Second,
what methods to improve influenza coverage among HCP
have been reported in the peer-reviewed literature?
Assessing why HCP are or are not willing to receive
influenza vaccine
In a recent article published in the Israel Journal of
Health Policy Research, Nutman and Yoeli reported on
Page 2 of 5
an assessment of the knowledge, perceptions and atti-
tudes concerning influenza vaccination among HCP in a
large tertiary care academic hospital in Israel [14]. The
authors obtained their information by means of an
anonymous survey completed by 468 HCP representing
all categories of staff. The overall frequency of influenza
immunization among these HCP was 42% (physicians,
56%; nurses, 41%; allied health professionals, 37%; and,
administrators and support personnel, 30%). Key findings
were as follows: (1) most HCP understood that influenza
is widespread and can have severe complications including
death; (2) only ~82% agreed that hospital personnel are at
an increased risk of contracting influenza because of their
job; (3) only ~62% believed that influenza immunization is
the only effective way to prevent infection; (4) only about
60% disagreed that vaccine side effects can be more severe
than influenza; (5) ~50% believed that influenza vaccine
can cause influenza; (6) >10% believed that pregnant
women should not be immunized; (7) only ~30% thought
that if they were not immunized they would become ill
with influenza; (8) less than 50% recommend influenza
vaccine to their patients; and (9) ~50% were in favor of
mandatory immunization of HCP. In the multivariate
analysis, items that were independent predictors of
immunization were beliefs that: vaccine effectively pre-
vents influenza, HCP are at increased risk of influenza,
contracting influenza is likely in the absence of
immunization, and HCP might transmit influenza to
their families.
The study by Nutman and Yoeli provided similar
information to studies in other developed countries. The
influenza vaccine vaccination rate of 42% in their
hospital is similar to rates reported from many European
countries [8], but well below the 77.3% reported in the
US [15]. For both Israel and the US, physicians and nurses
reported a higher frequency of influenza immunization
than allied health professionals and nonclinical HCP.
Other surveys which assessed the knowledge, perceptions
and attitudes concerning influenza vaccine by HCP have
reported similar results as the study by Nutman and Yoeli
[16–19]. Beliefs encouraging influenza immunization have
generally included a desire to protect oneself and to a
lesser extent to protect patients. Other factors favoring
immunization include free and convenient immunization,
being previously immunized, and peer-pressure and/or
support by senior administration. Beliefs reducing the like-
lihood of immunization have included fear of adverse
events, misconception that influenza vaccine can cause
influenza, belief that the person is not at risk, doubt that
influenza is a serious disease, concern that the vaccine is
ineffective, fear of injections, and that times/locations for
immunization were inconvenient. It is highly disturbing
that HCP frequently hold misconceptions regarding influ-
enza such as the lack of severity of influenza and risks for
Weber et al. Israel Journal of Health Policy Research (2016) 5:61
generally healthy HCP, as well as holding misconceptions
regarding the vaccine such as the vaccine can cause influ-
enza and that adverse events are common. Space limita-
tions preclude a detailed review of the science debunking
these misconceptions. However, by way of example, we
can note that in Israel, influenza vaccine has been shown
to reduce influenza in HCP [20]. Further, multiple studies
which have evaluated the frequency of adverse events
following influenza immunization of HCP have reported
that they are mild and transient [21–23]. The vast ma-
jority of influenza vaccines used around the world are
inactivated, many which are split or subviron which
cannot possibly cause influenza.
Improving influenza coverage among HCP
As already noted the public health authorities in many
countries, as well as many professional organizations,
recommend that all HCP should receive a dose of influ-
enza vaccine each year. For example, the Israel Ministry
of Public Health includes influenza vaccine coverage
among its ongoing quality measures for healthcare orga-
nizations which will help increase coverage rates. This
public health recommendation is based on sound public
health and the peer-reviewed literature. Given this well-
founded recommendation, what methods have been
demonstrated to improve influenza vaccine coverage
among HCP? The 2005, SHEA Guideline listed the
following barriers and solutions to HCP influenza
immunization [24]: (1) Inconvenient access to vaccine
(solution: off-hours clinics, use of mobile vaccination
carts, vaccination at staff and department meetings, and
provision of adequate staff and resources; (2) Cost (solu-
tion: provision of free vaccine); (3) concerns for vaccine
adverse events (solution: targeted education including
specific information to dispel vaccine myths); and (4)
other (solution: strong and viable administrative leader-
ship, visible vaccination of key leaders, active declination
of HCP who do not wish or cannot be vaccinated, accur-
ate tracking of individual HCP and unit-based compli-
ance of HCP with vaccination, and surveillance for
healthcare-associated influenza). Since this publication,
substantial additional research has been published on
the effectiveness of different methods to improve influ-
enza vaccine acceptance by HCP (Table 1) [24–35].
Several methods for increasing HCP compliance with
influenza immunization deserve further discussion; the
use of declination forms, the requirement that HCP who
are unable or unwilling to receive influenza vaccine wear
a surgical mask while providing patient care or while on
a patient unit, and “mandatory” influenza immunization.
The 2005 SHEA Guideline on influenza vaccination of
HCP recommended as one modality to increase influ-
enza uptake, the use of a declination form to be signed
by HCP who were unwilling to accept vaccine [24]. This
Page 3 of 5
Table 1 Interventions That Improve Influenza Vaccine Coverage
for Healthcare Personnel
• Mobile carts
• Free vaccine
• Adequate staff resources for vaccine campaign
• Education on benefits and risks (or lack of risks) for immunization
• Incentives for immunization
• Immunizations available on nights and weekends
• Immunization available at convenient locations (e.g., meetings,
common areas)
• Administrative support including visible vaccination of key personnel
• Tracing vaccination by individual healthcare providers and hospital
units with regular feedback to healthcare providers and administrators
• Sanctions for failure to be immunized
• Employment conditional upon receipt of vaccine
declination form described the risk to the HCP and their
patients from the HCP refusing immunization. Subse-
quent research has demonstrated that use of such forms
was associated with only a modest increase in vaccine
use by HCP, even when combined with other strategies
to increase vaccine coverage. Multiple studies demon-
strated that the introduction of declination forms con-
tinued to lead to vaccine coverage <80% [36–38] and
often <70% [39]. The 2010 revised SHEA Guideline on
influenza vaccination of HCP included the statement
“the use of statements (i.e., declination forms) should
not be viewed as the primary method for increasing
vaccination rates’ [11].
Another intervention that has been recommended is
to require unvaccinated HCP to wear a surgical mask
during the influenza season [11]. Several potential issues
related to the masking requirement have been raised.
First, implementation of such a policy is logistically chal-
lenging (i.e., developing methods to identify those HCP
required to wear a mask during clinical care). It has
proved difficult to develop a simple method to identify
such HCP without stigmatizing those HCP who chose
not to be vaccinated or were unable to be vaccinated
due to vaccine contra-indications. Second, few studies
that have assessed the success of this policy have
reported on the number of non-compliers and what
penalties were assessed for non-compliance.
Research has revealed that hospitals which include dis-
incentives for HCP refusing influenza vaccine have
higher rates of influenza vaccine coverage [39–41].
Examples of disincentives have included requirement to
sign a vaccine declination form and a requirement that
non-immunized persons wear a surgical mask while on
clinical units. The most successful strategy to improve
HCP influenza vaccine coverage has been to make receipt
of vaccine as a condition of employment (i.e., “mandatory”
Weber et al. Israel Journal of Health Policy Research (2016) 5:61
immunizations). Hospitals employing this strategy exempt
HCP with a contra-indication to immunization and some
also exempt HCP with a religious objection. Multiple
reports of hospitals that use this strategy have reported
vaccine coverage rates >95% [15, 39, 42, 43]. Increasing
numbers of hospitals in the US now require receipt of
influenza vaccine as a condition of employment (HCP
with a contra-indication are usually exempt) [15]. Concern
has been raised about the ethics of “mandatory”
immunization of HCP. However, multiple professional
societies have endorsed that employment as a HCP
should be conditional on willingness to receive influenza
vaccine, as vaccine protects both the HCP and the patient.
Conclusions
Influenza causes substantial morbidity and mortality
worldwide each year. Healthcare-associated influenza is
a frequent event. HCP may be the source for infecting
patients and may propagate nosocomial outbreaks. All
HCP should receive a dose of influenza vaccine each
year to protect themselves and others. Unfortunately, as
noted by Nutman and Yoeli in this issue many HCP in
Israel choose not to receive influenza immunization and
many harbor misconceptions regarding their risk for influ-
enza as well as the benefits of influenza vaccine. Multiple
proven methods can be used by healthcare facilities to
improve influenza vaccine coverage among HCP
(Table 1). The only proven method to reliably achieve a
coverage level >95% is to require influenza immunization
as a condition of employment.
Abbreviations
HCP: Healthcare personnel; SHEA: Society for Healthcare Epidemiology of
America; WHO: World Health Organization
Acknowledgement
None
Funding
No funding was obtained to support this paper.
Availability of data and materials
No primary data or materials were presented in this commentary.
Authors’ contributions
All authors participated in writing and reviewing this paper. All authors read
and approved the final manuscript.
Authors’ information
DJW is a liaison member of the ACIP; WO is a former Assistant Surgeon General
of the US Public Health Service and is Associate Director of the Emory Vaccine
Center; WAR is Director of Hospital Epidemiology, UNC Health Care.
Commentary on
Nutman A, Yoeli N. Influenza vaccination motivators among healthcare
personnel in a large acute care hospital in Israel. Israel Journal of Health
Policy Research 2016; 5:52. DOI: 10.1186/s13584-016-0112-5.
Competing interests
The authors declare that they have no competing interests.
Page 4 of 5
Consent for publication
All authors approved this paper for publication.
Ethics approval and consent to participate
Not applicable (not human research).
Author details
1
Department of Hospital Epidemiology, University of North Carolina Health
Care, 2163 Bioinformatics, CB #7030, Chapel Hill, NC 27599-7030, USA.
2
Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC,
USA. 3Division of Infectious Diseases, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, USA.
Received: 28 September 2016 Accepted: 28 November 2016
References
1. Weber DJ, Rutala WA, Schaffner W. Lessons learned: protection of healthcare
workers from infectious disease risks. Crit Care Med. 2010;38(8 Suppl):S306–14.
2. Pittet D, Allegranzi B, Boyce J, World Health Organization World Alliance for
Patient Safety First Global Patient Safety Challenge Core Group of Experts.
The world health organization guidelines on hand hygiene in health care
and their consensus recommendations. Infect Control Hosp Epidemiol.
2009;30:611–22.
3. Siegel JD, Rhinehart E, Marguerite Jackson M, Chiarello L, the Healthcare
Infection Control Practices Advisory Committee. 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings. http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html.
Accessed 10 September 2016.
4. Centers for Disease Control and Prevention. Immunization of Health-Care
Personnel: Recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR Rec Reports. 2011;60(RR07):1–45.
5. Centers for Disease Control and Prevention. Recommended Adult
Immunization Schedule - United States – 2016. https://www.cdc.gov/
vaccines/schedules/hcp/adult.html. Accessed 10 September 2016.
6. World Health Organization. WHO recommendations for routine
immunization – summary tables. Table 4, vaccination of health care
workers. http://www.who.int/immunization/policy/immunization_tables/en/.
Accessed 10 September 2016.
7. Maltezou HC, Poland GA. Vaccination policies for health-care workers
Europe. Vaccine. 2014;32:4876–80.
8. Haviari S, Bénet T, Saadatian-Elahi M, André P, Loulergue P, Vanhems P.
Vaccination of healthcare workers: a review. Hum Vaccin Immunother. 2015;
11:2522–37.
9. World Health Organization. Influenza (seasonal). http://www.who.int/
mediacentre/factsheets/fs211/en/. Accessed 10 September 2016.
10. Centers for Disease Control and Prevention. Influenza vaccination of health-
care personnel: Recommendations of the Healthcare Infection Control
Practices Advisory Committee (HICPAC) and the Advisory Committee on
Immunization Practices (ACIP). MMWR Rec Reports. 2006;55(RR02):1–16.
11. Talbot TR, Babcock H, Caplan AL, Cotton D, Maragakis LL, Poland GA, Septimus
EJ, Tapper ML, Weber DJ. Revised SHEA position paper: influenza vaccination
of healthcare personnel. Infect Control Hosp Epidemiol. 2010;31:987–9.
12. Vanhems P, Bénet T, Munier-Marion E. Nosocomial influenza: encouraging
insights and future challenges. Curr Opin Infect Dis. 2016;29:366–72.
13. Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of
influenza vaccination of healthcare personnel on morbidity and mortality
among patients: systematic review and grading of evidence. Clin Infect Dis.
2014;58:50–7.
14. Nutman A, Yoeli N. Influenza vaccination motivators among healthcare
personnel in a large acute care hospital in Israel. Israel Journal of Health
Policy Research. 2016;5:52.
15. Black CL, Yue X, Ball SW, Donahue SM, Izrael D, de Perio MA, Laney AS,
Williams WW, Lindley MC, Graitcer SB, Lu PJ, Bridges CB, DiSogra C,
Sokolowski J, Walker DK, Greby SM. Influenza vaccination coverage among
health care personnel–united states, 2014–15 influenza season. MMWR
Morb Mortal Wkly Rep. 2015;64:993–9.
16. Hofmann F, Ferracin C, Marsh G, Dumas R. Influenza vaccination of
healthcare workers: a literature review of attitudes and beliefs. Infection.
2006;34:142–7.
Weber et al. Israel Journal of Health Policy Research (2016) 5:61 Page 5 of 5

17. Corace K, Prematunge C, McCarthy A, Nair RC, Roth V, Hayes T, Suh KN, declination form in a program for influenza vaccination of healthcare
Balfour L, Garber G. Predicting influenza vaccination uptake among workers. Infect Control Hosp Epidemiol. 2008;29:302–8.
health care workers: what are the key motivators? Am J Infect Control. 39. Talbot TR. Do declination statements increase health care worker influenza
2013;41:679–84. vaccination rates? Clin Infect Dis. 2009;49:773–9.
18. Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of 40. Fricke KL, Gastañaduy MM, Klos R, Bégué RE. Correlates of improved
health care workers in hospitals–a review of studies on attitudes and influenza vaccination of healthcare personnel: a survey of hospitals in
predictors. Vaccine. 2009;27:3935–44. Louisiana. Infect Control Hosp Epidemiol. 2013;34:723–9.
19. Prematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G. Factors 41. Miller BL, Ahmed F, Lindley MC, Wortley PM. Institutional requirements for
influencing pandemic influenza vaccination of healthcare workers-a influenza vaccination of healthcare personnel: results from a nationally
systematic review. Vaccine. 2012;30:4733–43. representative survey of acute care hospitals–United States, 2011. Clin Infect
20. Atamna Z, Chazan B, Nitzan O, Colodner R, Kfir H, Strauss M, Schwartz N, Dis. 2011;53:1051–9.
Markel A. Seasonal influenza vaccination effectiveness and compliance 42. Pitts S, Maruthur NM, Millar KR, Perl TM, Segal J. A systematic review of
among hospital health care workers. Isr Med Assoc J. 2016;18:5–9. mandatory influenza vaccination in healthcare personnel. Am J Prev Med.
21. Park SW, Lee JH, Kim ES, Kwak YG, Moon CS, Yeom JS, Lee JH, Lee CS. 2014;47:330–40.
Adverse events associated with the 2009 H1N1 influenza vaccination and 43. Johnson JG, Talbot TR. New approaches for influenza vaccination of
the vaccination coverage rate in health care workers. Am J Infect Control. healthcare workers. Curr Opin Infect Dis. 2011;24:363–9.
2011;39:69–71.
22. Regan AK, Tracey L, Gibbs R. Post-marketing surveillance of adverse events
following immunization with inactivated quadrivalent and trivalent
influenza vaccine in health care providers in Western Australia. Vaccine.
2015;33:6149–51.
23. McEvoy SP. A retrospective survey of the safety of trivalent influenza
vaccine among adults working in healthcare settings in south metropolitan
Perth, Western Australia, in 2010. Vaccine. 2012;30:2801–4.
24. Talbot TR, Bradley SE, Cosgrove SE, Ruef C, Siegel JD, Weber DJ. Influenza
vaccination of healthcare workers and vaccine allocation for healthcare workers
during vaccine shortages. Infect Control Hosp Epidemiol. 2005;26:882–90.
25. Sartor C, Tissot-Dupont H, Zandotti C, Martin F, Roques P, Drancourt M. Use
of a mobile cart influenza program for vaccination of hospital employees.
Infect Control Hosp Epidemiol. 2004;25:918–22.
26. Salgado CD, Giannetta ET, Hayden FG, Farr BM. Preventing nosocomial
influenza by improving the vaccine acceptance rate of clinicians. Infect
Control Hosp Epidemiol. 2004;25:923–8.
27. Lee HY, Fong YT. On-site influenza vaccination arrangements improved
influenza vaccination rate of employees of a tertiary hospital in Singapore.
Am J Infect Control. 2007;35:481–3.
28. Zimmerman RK, Nowalk MP, Lin CJ, Raymund M, Fox DE, Harper JD, Tanis MD,
Willis BC. Factorial design for improving influenza vaccination among employees
of a large health system. Infect Control Hosp Epidemiol. 2009;30:691–7.
29. Song JY, Park CW, Jeong HW, Cheong HJ, Kim WJ, Kim SR. Effect of a
hospital campaign for influenza vaccination of healthcare workers. Infect
Control Hosp Epidemiol. 2006;27:612–7.
30. Harbarth S, Siegrist CA, Schira JC, Wunderli W, Pittet D. Influenza
immunization: improving compliance of healthcare workers. Infect Control
Hosp Epidemiol. 1998;19:337–4.
31. Talbot TR, Dellit TH, Hebden J, Sama D, Cuny J. Factors associated with
increased healthcare worker influenza vaccination rates: results from a
national survey of university hospitals and medical centers. Infect Control
Hosp Epidemiol. 2010;31:456–62.
32. Palmore TN, Vandersluis JP, Morris J, Michelin A, Ruprecht LM, Schmitt JM,
Henderson DK. A successful mandatory influenza vaccination campaign
using an innovative electronic tracking system. Infect Control Hosp
Epidemiol. 2009;30:1137–42.
33. Polgreen PM, Chen Y, Beekmann S, Srinivasan A, Neill MA, Gay T,
Cavanaugh JE, Infectious Diseases Society of America's Emerging Infections
Network. Elements of influenza vaccination programs that predict higher
vaccination rates: results of an emerging infections network survey. Clin
Infect Dis. 2008;46:14–9. Submit your next manuscript to BioMed Central
34. Babcock HM, Gemeinhart N, Jones M, Dunagan WC, Woeltje KF. Mandatory and we will help you at every step:
influenza vaccination of health care workers: translating policy to practice.
Clin Infect Dis. 2010;50:459–64. • We accept pre-submission inquiries
35. Huynh S, Poduska P, Mallozzi T, Culler F. Mandatory influenza vaccination of • Our selector tool helps you to find the most relevant journal
health care workers: a first-year success implementation by a community
• We provide round the clock customer support
health care system. Am J Infect Control. 2012;40:771–3.
36. LaVela SL, Hill JN, Smith BM, Evans CT, Goldstein B, Martinello R. Healthcare • Convenient online submission
worker influenza declination form program. Am J Infect Control. 2015;43:624–8. • Thorough peer review
37. Ajenjo MC, Woeltje KF, Babcock HM, Gemeinhart N, Jones M, Fraser VJ.
• Inclusion in PubMed and all major indexing services
Influenza vaccination among healthcare workers: ten-year experience of a
large healthcare organization. Infect Control Hosp Epidemiol. 2010;31:233–40. • Maximum visibility for your research
38. Ribner BS, Hall C, Steinberg JP, Bornstein WA, Chakkalakal R, Emamifar A,
Eichel I, Lee PC, Castellano PZ, Grossman GD. Use of a mandatory Submit your manuscript at
www.biomedcentral.com/submit